Housing Voucher Discrimination and Deaths of Despair
Date
2024-03-07
Authors
Meredith, Neil R.
Brooks, Christopher A.
Meredith, Amy A.
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Journal ISSN
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Abstract
Housing policy relating to the opioid epidemic is receiving increased scrutiny. Concerns have arisen that rejecting housing vouchers is harming public health. We estimate the relationship between legalizing housing discrimination of Section 8 housing vouchers (VDA) and deaths of despair using state level mortality data on U.S. adults from the Centers for Disease and Control database. Leveraging 2015 legislation in Texas and Indiana that legalizes Section 8 housing voucher discrimination, results suggest the policy increased the prescription opioid mortality rate by 2.438 deaths per 100,000 people. The findings imply that legalizing Section 8 housing discrimination may worsen public health in the ongoing opioid crisis.
Description
While housing voucher discrimination occurs throughout the United States, Texas and Indiana explicitly demonstrate this reality. Under Texas and Indiana law enacted in 2015 and effective in 2016, landlords can refuse to accept Section 8 housing vouchers' a vital form of rental assistance, as explained by Walters and Satija (2018). As a result, individuals receiving housing vouchers may be unable to find landlords who will accept them. For instance, Walters and Satija (2018) note that 1 in 4 families receiving a housing voucher in the Houston, Texas area never get to use it. While this source of income discrimination arguably reduces housing accessibility, it could have other effects. Namely, permitting voucher discrimination may produce the unintended consequence of worsening the ongoing opioid epidemic. According to Venkataramani and Tsai (2020), opioid deaths, suicide, and alcohol related mortality constitute deaths of despair and contribute to rising midlife mortality rates. Ashley C. Bradford and W. David Bradford (2020) note that the CDC measures deaths of despair in the context of the substances used such as heroin, benzodiazepines, psychostimulants, cocaine, antidepressants, and alcohol. Allik et al. (2020) attest that the deaths of despair stem from economic pressures and breakdowns in social support structures. Given the economic and social pressures that people can face as a result of housing instability, there is concern that housing discrimination could lead to more deaths of despair. To provide new information on housing policy, we conduct our study to provide the first empirical estimate of the effects of introducing legal source of income discrimination on deaths of despair. We use a difference-in-differences empirical approach to evaluate if legal voucher discrimination leads to higher substance-related mortality rates for all opioids, prescription opioids, synthetic opioids, heroin, cocaine, stimulants, benzodiazepines, antidepressants, and alcohol poisoning. Our results directly address a paucity of research that exists on source of income discrimination and deaths of despair. Our contribution expands the existing body of research, including the A. C. Bradford and W. D. Bradford (2020) study on evictions and housing discrimination. Empirical results from the CDC WONDER database reveal that introducing a legal discrimination policy for Section 8 vouchers in Texas and Indiana in 2016 increases mortality from prescription opioids. Specifically, we report that the source of income discrimination policy increased the prescription opioid mortality rate by 2.438 deaths per 100,000 people. The increase suggests that policymakers should be aware that an unintended consequence of voucher discrimination is higher mortality in the opioid epidemic. As one consideration, stakeholders in Section 8 housing vouchers may wish to make the program and its requirements easier to administer and carry out to help prevent discrimination and its legalization from occurring.
Data for our analysis comes from a collection of sources for the years 2010-2018 at the state level. Our dependent variables are the rates of poisoning from nine substance categories that represent "deaths of despair" . The CDC National Center for Health Statistics National Vital Statistic System originally collects data on the nine causes of substance-related deaths and provides access through the CDC WONDER database. The CDC classifies the nine causes with the standard International Classification of Diseases, Tenth Revision (ICD-10) underlying cause of death codes using 20-underlying cause of death fields including overall opioid use (T40.0-T40.4, T40.6), prescription opioids (T40.2-T40.3), synthetic opioids (T40.4), heroin (T40.1), cocaine (T40.5), stimulants (T43.6), benzodiazepines (T42.4), antidepressants (T43,0-T43.2), and alcohol poisoning (X45, Y15). Due to confidentiality and privacy concerns, the CDC WONDER database only provides public data in cases where a state has at least 10 deaths with a substance-related cause. Our dependent variables contain the number of deaths where a substance is one of multiple possible underlying causes of death. Some deaths include more than one substance (e.g. heroin and prescription opioids together) as possible causes. Therefore, we cannot add the number of deaths in our data to compute a total number of substance deaths because of double-counting. We calculate our nine mortality rate dependent variables by weighting state-level deaths by state population per 100,000 residents. Because our empirical strategy closely follows the approach of Ashley C. Bradford and W. David Bradford (2020), we use independent variables that closely align with them. Our first independent variable is the state-level eviction rate per 100 households. We compute the eviction rate by dividing the number of eviction judgements by the number of renter-occupied houses and multiplying by 100. Data for evictions and renter-occupied houses comes from the Eviction Lab at Princeton University. The Eviction Lab extracts data for 46 states and the District of Columbia from partnerships with record-collecting companies, text parsing, web scraping, and court records. The most recent year of available data on evictions is 2018, which is why our sample ends in 2018. The next set of independent variables that we employ serve as demographic controls. The controls include the state population, percent population that is male, percent population aged 18-64 years, percent population that is white, state income per capita, poverty rate, percent population with no health insurance, unemployment rate, and the active physician rate. We collect data for these measures from the U.S. Department of Health & Human Services’ 2011-2021 Area Health Resources Files. The earliest year that our demographic controls have data available is 2010, which is why our sample begins in 2010. As Ashley C. Bradford and W. David Bradford (2020) note and Buchmueller and Carey (2018) attest, the existence of a must-access prescription drug monitoring program (PDMP) system in a state can have a statistically significant effect on opioid use. Therefore, our last independent variable is PDMP, where a 1 indicates the presence of a must-access PDMP system in a state and a 0 indicates a lack thereof. Data for PDMP comes from the Prescription Drug Abuse Policy System at Temple University.
Keywords
West Texas A&M University, College of Business, Poster, Section 8 housing, Housing vouchers, Public health